Management of Attention-Deficit Hyperactivity Disorder Children for Dental Procedures.

Background A common psychiatric problem called attention-deficit hyperactivity disorder (ADHD) is characterized by impulsivity with resultant behavior issues and a very short attention span. The purpose of this study was to evaluate and compare the management of dental procedures in children with and without ADHD employing various behavior modification techniques. Materials and methods The study consisted of 121 children divided into two groups with 60 children diagnosed with ADHD and 60 children without ADHD between 7 and 15 years of age. Each of the three sessions, which were spaced a week apart, included a dental examination, oral prophylaxis, and a minor restorative procedure. The pulse rate (PR) and oxygen saturation (SpO2) were measured during each of these sessions. The study was conducted to evaluate the Tell-Show-Do (TSD) method, audiovisual distraction, and pharmacological management of children with and without ADHD during the dental procedure. IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States) was used to statistically analyze the findings. The mean values of the parameters from the three sessions were analyzed and compared using the Z-test. Result The children with ADHD included 39 (65%) boys and 21 (35%) girls, and the children without ADHD consisted of 27 (44.26%) boys and 33 (54.09%) girls. The mean values of the PR during sessions two and three were found to be statistically highly significant between the children with and without ADHD for TSD and audiovisual aids. In both groups, the mean SpO2 values for all the sessions were found to be statistically highly significant for the techniques evaluated (p<0.01). The change in the mean PR score for the ADHD children revealed a declining trend from sessions one through three for all the techniques evaluated (p<0.05), demonstrating a statistically significant effectiveness of the various techniques between the two groups and thereby revealing a decreased level of anxiety. Between sessions one and three, all of the three techniques showed a decreasing trend of SpO2 scores, with the exception of the pharmacological management of ADHD children (p<0.01) indicating that the uncontrollable ADHD children feel less anxious than in the other two approaches. Conclusion The findings of the study demonstrated that behavior management techniques were found to be effective at reducing anxiety in ADHD children than in children without ADHD. Our study further suggests that scheduling dental appointments into a series of short visits could enhance the effectiveness of the therapy and better cooperation of the children.

The Cervical Abrasion Index of Treatment Needs (CAITN) Procedure for Population Groups and Individuals.

Because of their complex epidemiology and etiology, cervical abrasions usually manifest with concealing symptoms. The buccolingual dimension of the sore is considered the most important metric to rank the damage and evaluate its long-term prognosis. In this piece, we will break this down and offer the Cervical Abrasion Index of Treatment Needs (CAITN), a simple grouping structure based on the clinical presentation of the sore that may be used to establish a basic, useful, treatment-based order. CAITN is the practical approach to routine screening and recording cervical abrasion lesions. The index provides epidemiologists, public health professionals, and practitioners with a practical means of assessing the treatment needs (TN) of cervical abrasion.

Assessment of Patients' Experience and Perception Toward Dentinal Hypersensitivity for Its Diagnosis and Management: A Cross-Sectional Study.

Background Dentinal hypersensitivity (DH) is a common clinical finding that varies greatly in prevalence. An appropriate impulse that detonates noxious stimuli in the pulp/dentin boundary causes the typical DH pain, which is sudden, short, sharp, and of rapid onset. The objective of this research was to ascertain the incidence of DH in Keralites and evaluate some contributory factors, along with other initiating stimuli. Methodology Over three months, from June 2022 to August 2022, a cluster sampling technique was employed to conduct the study in 14 districts of Kerala. Patients from five clinics from each district who reported having DH and were aged 25 to 65 years were chosen at random. Using Google Survey forms, a 20-question, closed-ended survey was mailed to patients. The data were collected, evaluated, and analyzed using SPSS Version 23.0 (IBM Corp., Armonk, NY, USA). The statistical difference in the distribution of DH and the patient's age was determined using analysis of variance (ANOVA). A chi-square test was carried out to test the association between dentinal hypersensitivity, gender, and other parameters; P < 0.05 was considered to be statistically significant. Results Among the 2,520 persons to whom questionnaires were mailed, 2,321 responded, with an unresponsive rate of 7.89%. The study revealed a sensitivity predilection among females (54%), although statistically insignificant. Respondents aged 25 to 35 years (41.01%) were commonly reported to have DH, the age distribution of which was found to be highly significant statistically (P < 0.01). Teeth whitening resulted in 82.98% of the sensitivity, whereas 47.99% accepted poor oral hygiene as an additional contributory factor. DH was reported in 52.01% of the patients with gastritis and 63.03% of the patients with gingival recession. Further, blame for poor dental treatment (88.88%) and climate change (82.92%) were also found relevant. The quality of life was claimed to be afflicted in 90.99% of the patients. Desensitizing agents were used by 68.97% of the patients, with which 68.03% reported satisfaction. Of the subjects who underwent professional treatment, 87.03% reported being satisfied. Oral prophylaxis-induced sensitivity was reported in 57.99%, indicating enhanced oral health awareness among Kerala residents. There was a statistically highly significant difference in the patient distribution based on the exposure to DH, and their perception of the causes and factors affecting DH (P < 0.01). Conclusions DH is a frequently and widely prevalent dental malady. Respondents demonstrated that they were conversant with DH. The quality of life and enjoyment of daily activities are both impacted by dentin hypersensitivity, and many patients are unaware that it is a treatable illness. Various desensitizing substances are also available and can be applied quickly to sensitive areas. Patients prefer this procedure as it is simpler to apply these agents and the effects are pleasant and beneficial.

Evaluation of Some Dental Myths Among the Adult Population in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Background To provide effective oral health care to patients and healthy individuals, it is critical to recognize prevalent myths. Most myths cause patients to follow the wrong protocol in dentistry, which can make treatment difficult for the dentist. This study aimed to assess dental myths among the Saudi Arabian population in Riyadh. Methodology A descriptive cross-sectional questionnaire survey was conducted among Riyadh adults between August and October 2021. Saudi nationals aged 18-65 living in Riyadh without cognitive, hearing, or vision impairments and with limited or no trouble interpreting the questionnaire were surveyed. Only participants who consented to participate in the study were included. JMP Pro 15.2.0 was used to evaluate survey data. Frequency and percentage distributions were used for dependent and independent variables. The chi-square test evaluated the statistical significance of the variables, with a p-value of 0.05 being considered statistically significant. Results A total of 433 participants completed the survey. Half of the sample (50%) were aged 18-28; 50% were men; and 75% had a college degree. Higher-educated men and women did better on the survey. In particular, 80% of the participants believed "teething causes fever." "Placing a (pain killer) tablet on a tooth reduces pain" was believed by 34.40% of the participants, and 26% thought pregnant women should not get dental work. Lastly, 79% of the participants believed that "infants obtain calcium from their mother's teeth and bone." Most sources of these pieces of information were online (62.60%). Conclusions Nearly half of the participants believe in dental health myths, and as a result, people follow unhealthy practices. This results in long-term health consequences. The government and health professionals must prevent the spread of such misconceptions. In this regard, dental health education may be helpful. Most of this study's crucial findings are consistent with those of prior studies, indicating its accuracy.

Assessment of Cervical Abrasion, Dentin Hypersensitivity, and Its Treatment Needs Using the Cervical Abrasion Index of Treatment Needs Probe.

Objective This study was intended to compare the mean buccolingual measurement of abraded teeth with/without sensitivity. The hypothesis was that the suggested treatment approaches would be in agreement with that of the treatment needs (TN) elicited using the Cervical Abrasion Index of Treatment Needs (CAITN) probe and aid in the development of a prospective CAITN index for clinical/community studies of effective therapeutic measures. Materials and methods  A cross-sectional study was carried out on 30 individuals with a mean age of 48.4±12.54 years, comprising 840 teeth with/without cervical abrasion. The buccolingual measurement of each tooth was recorded using the CAITN probe. The response to air-blast was assessed by a short blast of one-second duration at a distance of 1 cm for each tooth. An endodontist was also asked to indicate the treatment methods used by him for the treatment of abrasions. His opinions regarding the TN were later compared with the data collected by an investigator. Results The mean buccolingual measurements of all the teeth were compared with the dentinal sensitivity using the independent t-test and were statistically highly significant. Furthermore, one-way analysis of variance disclosed that there was a statistically highly significant difference found for all the TN (p<0.01) such as none, preventive, basic, and advanced restorative TN followed by Tukey honestly significant difference post hoc tests for multiple pair-wise comparisons. The running receiver operator characteristic curve discloses the best cut-off value of the buccolingual measurement to predict the various categories of TN of each tooth. As the area under the curve is more close to 1 (noticed in the majority of the teeth in the sample), the model predicts the TN more precisely based on the buccolingual measurements. Conclusion The present study enables a correct diagnosis of cervical abrasions and determines the various TN with the most appropriate restorative material. These baseline data help to design clinical studies that test relevant treatment and diagnostic strategies.

Renal artery aneurysm: a report of 28 cases.

Renal artery aneurysms are being increasingly encountered due to the wider use of angiography. From 1972 to 1992, 28 patients with renal artery aneurysm were identified in the present study, including 18 women and 10 men, with a mean age of 58 years. The aneurysms were discovered incidentally in 39% of patients during evaluation for hypertension in 39%, and during investigation of abdominal pain in 22%. Only 7% of patients had symptoms directly attributable to the aneurysm. Aneurysm size varied from 0.5cm to 8cm in diameter, with a mean of 2.1 cm. The main renal artery was involved in 52% of cases, and primary branches in 44%; the remainder were intraparenchymal. There was a slight right-sided predominance in this series. The etiology of the aneurysms included atherosclerosis (75%), fibromuscular disease (21%), and Ehlers-Danlos syndrome (4%). Surgical therapy was undertaken in 10 patients (36%). Procedures performed included aortorenal bypass in four patients, aneurysm excision and renal artery repair in three, partial nephrectomy in one, and total nephrectomy in two. Although the natural history of renal artery macroaneurysms is not known with certainty, potential complications include embolization and rupture. The authors' indications for surgery include: (a) symptomatic or enlarging aneurysms; (b) renal embolization; (c) aneurysms in pregnant females or those considering pregnancy; (d) renovascular hypertension; (e) aneurysms> 2.5cm. Most symptom-free aneurysm s<2.5 cm in diameter can be safely treated expectantly.

Characterization of thrombin receptor expression during vascular lesion formation.

Blood vessels respond to injury by initiating cell proliferation and migration that result in vascular lesion formation. To determine the roles of thrombin and the thrombin receptor in this process, we characterized thrombin receptor expression in normal and injured arteries, thrombin receptor-mediated smooth muscle cell mitogenesis, and the regulation of thrombin receptor mRNA expression in vitro. Thrombin receptor mRNA was not detected in normal rat or baboon arteries by in situ hybridization. Immunohistochemistry using an antithrombin receptor antibody (TR-R9), directed against the thrombin cleavage site of the rat aortic smooth muscle cell thrombin receptor, revealed low-level staining for thrombin receptor protein in endothelial cells and smooth muscle cells of normal arteries. In contrast, balloon catheter injury increased thrombin mRNA expression in medial smooth muscle cells within 6 hours. This increased thrombin receptor expression continued within the media and in neointimal cells throughout vascular lesion formation, predominantly in areas of active cell proliferation. In vitro, alpha-thrombin stimulates rat aortic smooth muscle cell proliferation in a concentration-dependent manner. That thrombin receptor activation is required for the mitogenic response was confirmed by demonstrating that the polyclonal antibody TR-R9 inhibits thrombin-induced cell proliferation. Thrombin receptor mRNA synthesis was induced by both basic fibroblast growth factor (maximal stimulation of 1.8-fold at 1 hour) and platelet-derived growth factor (maximal stimulation of 2.4-fold at 8 and 24 hours) in quiesced cultured rat aortic smooth muscle cells. In summary, upregulation of smooth muscle cell thrombin receptor expression occurs very early after vascular injury and continues throughout neointimal development.(ABSTRACT TRUNCATED AT 250 WORDS)

Reaction to injury following balloon angioplasty and intravascular stent placement in the canine femoral artery.

Intravascular stents are used clinically as an adjunct to coronary and iliac angioplasty. This study was performed to evaluate the thrombogenicity and intimal hyperplasia incited by stents deployed in non-injured and in balloon-injured femoral arteries in the canine model. Medinvent stents (4 mm) were placed in the femoral arteries bilaterally in five mongrel dogs via cut down. This was preceded by balloon catheter angioplasty of the stent site on one side. Platelet deposition was measured at 30, 60, and 90 minutes and at 24 and 48 hours after stent placement, using gamma camera imaging of Indium111 platelets. The animals were killed after 2 months using a pressure perfusion technique, and the stents harvested. All vessels were patent at the time of harvest. Neointimal thickness was measured by computer image analysis. Platelet deposition was significantly increased on the angioplastied side compared to the non-angioplastied side at 60 minutes (5.67 x 10(9) +/- 1.4 versus 2.17 x 10(9) +/- 0.5 platelets/cm; P < 0.05), at 90 minutes (8.13 x 10(9) +/- 1.8 versus 2.33 x 10(9) +/- 0.6 platelets/cm; P < 0.05), and at 24 hours (stent-to-blood ratio = 15.86 +/- 6.3 versus 3.75 +/- 1.5; P < 0.05). Neointimal thickness was also significantly greater on the side of combined angioplasty and stent placement (0.45 +/- 0.21 mm versus 0.33 +/- 0.09 mm; P < 0.05). These results demonstrate that placement of intravascular stents in normal arteries is associated with a certain degree of thrombogenicity and formation of neointimal hyperplasia. Combining balloon angioplasty with stent placement significantly augments both thrombogenicity and production of intimal hyperplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Subclavian artery revascularization: a decade of experience with extrathoracic bypass procedures.

Extrathoracic revascularization has become the most popular form of surgical correction of symptomatic subclavian artery lesions. During a 10-year period ending in December 1991, 41 extrathoracic bypass procedures were performed on 37 patients for proximal subclavian artery stenosis or occlusion. This included 25 females and 12 males, with a mean age of 56 years. Surgery was performed for manifestations of upper extremity ischemia in 19 patients (51%), vertebrobasilar insufficiency in four patients (11%), and both upper extremity ischemia and vertebrobasilar insufficiency in 11 patients (30%). Three patients (8%) had angina pectoris caused by "coronary-subclavian steal" following internal mammary-coronary artery bypass. Severe proximal stenosis or complete occlusion of the subclavian artery was demonstrated angiographically in all cases. Procedures performed included: carotid-subclavian bypass (n = 28), subclavian-carotid transposition (n = 6), axilloaxillary bypass (n = 4), and subclavian-subclavian bypass (n = 3). Saphenous vein was used as the bypass conduit in 6 of the carotid-subclavian bypass procedures, and prosthetic grafts were used for the remainder. There were no perioperative strokes or deaths in this series, and the mean postoperative hospital stay was 4 days. Follow-up ranged from 2 to 96 months (mean, 35.6 months). The overall patency rate was 95% at 1 year, 86% at 3 years, and 73% at 5 years. Patency at 5 years was significantly higher for procedures utilizing the common carotid artery as the donor vessel as compared with those using the contralateral subclavian or axillary arteries (83% versus 46%, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Extrathoracic bypass procedures for proximal common carotid artery lesions.

During a 10-year period ending in December 1991, 31 extrathoracic bypass procedures were performed in 29 patients for proximal common carotid artery atherosclerotic stenosis or occlusion. This included 16 men and 13 women, with a mean age of 63 years. Indications for surgery included transient ischemic attacks in 23 patients (79%), nonfocal symptoms in 4 patients (14%), and asymptomatic proximal common carotid artery stenosis associated with near-total occlusion of the internal carotid artery in 2 patients (7%). Severe proximal stenosis or complete occlusion of the common carotid artery was demonstrated angiographically in all cases. Subclavian-to-carotid bypass was performed in 26 cases and carotid-to-carotid bypass in 5 cases. Seventy-four percent of the bypass procedures were to the common carotid artery and 26% to the external carotid artery. Endarterectomy of the common carotid bifurcation was performed in conjunction with the bypass procedure in 13 cases and vertebral artery transposition in 2 other cases. Saphenous vein was used as the bypass conduit in 65% and prosthetic grafts in 35% of cases. There were no perioperative strokes or deaths in this series, and the mean postoperative hospital stay was 5 days. Follow-up ranged from 2 to 118 months (mean: 38.4 months). Graft occlusion occurred in two cases during the follow-up period (3-year patency rate: 90%), with recurrence of symptoms in one patient, which necessitated revision. Three patients had persistence or recurrence of symptoms despite patency of the graft, one other patient sustained a posterior circulation infarct, and there was one death unrelated to carotid vascular disease during the follow-up period. This experience shows that extrathoracic bypass procedures are safe and well tolerated for symptomatic proximal common carotid artery stenosis or occlusion. This method of reconstruction has excellent long-term patency and protection against further anterior circulation neurologic events.

Local infusion of fibrinolytic agents for acute renal artery thromboembolism: report of ten cases.

Management of acute renal artery occlusion remains a therapeutic challenge. We report our experience with 10 cases of acute renal artery occlusion treated primarily by local infusion of fibrinolytic agents. Renal artery occlusion occurred as a result of thrombosis of a stenosed vessel in three cases, from renal artery embolism in two cases, as a complication of percutaneous transluminal angioplasty in four cases, and in association with aortic occlusion in one case. Flank pain was present in all cases and hematuria in four cases. Acute renal failure was seen at the time of presentation in four cases (one case from bilateral occlusion and three cases from an associated nonfunctioning contralateral kidney). Diagnosis was confirmed by renal isotope scanning and arteriography in all cases. All patients were treated by selective infusion of streptokinase or urokinase into the occluded renal arteries. In five cases this was combined with balloon catheter angioplasty. Therapy was initiated within 24 hours from the onset of symptoms in three cases, within 3 days in four cases, within 6 days in two cases, and after 5 weeks in one case. Successful revascularization was initially achieved in 7 of the 10 cases by arteriographic criteria. Rethrombosis occurred in one patient after 3 days and fibrinolytic therapy was repeated successfully. Renal function was restored in one of the four patients presenting with acute renal failure. One complication necessitating resection occurred as a result of fibrinolytic therapy in the form of acute mesenteric embolism with descending colon infarction. No major bleeding complications were encountered and there were no deaths in this group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonoperative management of visceral aneurysms and pseudoaneurysms.

During the period from 1975 to 1991, 41 patients with 60 visceral artery aneurysms were treated at the Affiliated Hospitals of Emory University. The total included 13 patients in whom 16 aneurysms were treated primarily by transarterial embolization. There were seven hepatic artery aneurysms, three splenic artery aneurysms, three gastroduodenal artery aneurysms, two left gastric artery aneurysms, and one right gastroepiploic artery aneurysm. Average age of these patients was 50 years; there were eight males and five females. Seven patients presented with gastrointestinal bleeding, and two patients presented with abdominal pain. In four patients, the aneurysm was an incidental finding. Etiology of the true or false aneurysms consisted of pancreatitis in two patients, trauma in three patients, connective tissue disease in one, and was unknown in the remainder. Embolization was performed in seven cases with Gianturco coils and Gelfoam, with coils alone in four, with Gelfoam alone in four, and with detachable balloons in one instance. Complete occlusion was achieved initially in 13 cases. Recanalization occurred in two patients over a mean follow-up period of 8.6 months, requiring re-embolization in one patient, whereas the other patient was managed expectantly. In three cases, embolization was unsuccessful: two cases required surgical correction, and one case was managed expectantly. Only one complication was related to the embolization procedure, which was a common hepatic arterial dissection that proceeded to the formation of a false aneurysm. Embolization as the primary treatment modality for visceral artery aneurysms should be considered in patients with the following diagnoses: pseudoaneurysms associated with pancreatitis, intrahepatic aneurysms, most splenic artery aneurysms, and gastric, gastroduodenal, and gastroepiploic aneurysms. The procedure has a low risk and may obviate a difficult surgical procedure, but it does not preclude surgical intervention should the need arise.